Cardiothoracic

Surgery
I. Definition

Cardiothoracic surgery is the

surgery concerned with all structure
that lie within the thoracic cage like ,
ribs , lungs , heart , esophagus…
II . Types
A. Cardiac Operation :
1) Closed Cardiac , as ( closed mitral
valvotomy ‘CMV’ and closure of patent
ductus arteriosus PDA )
2) Open Cardiac :Using cardiopulmonary
by pass machine as in repair of
congenital heart disease and coronary
heart by pass graft..
 B. Non Cardiac Operation:
As lung resection
(pneumonectomy , lobectomy )
and thymectomy,
III. Incision :
Thoracotomy:
1- Definition: It is an incision into the
thoracic cavity to gain access to lungs ,
bronchi , heart and oesophagus.
 2-Types

Lateral Incision : Anterior Incision

A. Antero Lateral. A. Transverse.

B. Postero Lateral. B. Vertical.
 Anterolateral:
- Start close to midline in front, follows along the line
of a rib below the breast to the posterior axillary
line.
- Used for approaching anterior thoracic structures, as
in closed mitral valvotomy and pleurectomy.
- The muscle cut are pectoralis major and minor,
serratus anterior, internal and external
intercostals.
- The intercostals space is entered through the upper
border of the six or the fifth rib.
 Posterolateral
- Follow the vertebral border of the scapula and the
line of a rib ( 5,6,7 or 8 ).
- Used in dealing with posterior structures as in
lung operations.
- The muscle cut are trapezius, latissimus dorsi ,
rhomboids, serratus anterior , intercostals and
erector spinae.
- A rib may be removed , so that when other ribs
are retracted there is sufficient space for access to
the thorax
 Transverse.
- Submammary and bilateral, through the
fourth intercostal space and transversely
divide the sternum.
- The pectoralis major is divided together
with internal and external intercostals.
 Vertical
- The incision passes through the meeting
of the two pectoralis major in front of the
sternum and opening of the linea alba
(meeting of the two recti) then sawing of
the sternum.
- Used for doing more than 95% of open
heart surgery and in thymectomy.
IV. Drainage System:
1- Pleural cavity is a closed space with negative
pressure -3 to -5 to prevent collapse of the
lung.
2- Pericardial sac protect the heart.
Any collection of fluid or air will cause
impairment of respiration and cardiac function
in proportional to collected amount.
- Drainage : Removal of unwanted fluid and
air from the thorax following surgery or
trauma.
 *Types:
A. Closed : B. Opened :
-Simple air – tight system is used A tube may be
to allow drain and prevent air inserted into a
entry. pocket of pus
-Rubber tube introduced into the which then drain
interthoracic space and fixed out onto a dressing.
with suture.
-The other end connected to
calibrated glass tube which
terminates under the water.
- The oscillations of water inside
the under water pipe
represents the respiratory
movement.
*Causes of intra-thoracic Collection

1) After any thoracic operation.

2) Traumatic
3) Inflammatory.
4) Neoplastic.
*What will be drained

1) Air : Pneumo -thorax.

2) Blood : Haemo - thorax.
3) Serous : Hydro – thorax
4) Pus : Pyo – Thorax.
*Area of drain:

1- Pleural.
2- Mediastinal.
A) Pericardial.
B) Retrosternal.
*Points to be noted:
1. Amount and type of drainage:
- 200 ml in the first 24 hours.
- Air can be seen as a bubbles in the
water.
- If bubbles stop, it may because of :
a) all air has been removed.
b) the tube is locked.
2- Swing of water:
- The level of water fall in inspiration
and rises in expiration.
- If swing stop:
a) Lung is fully expanded.
b) tube is blocked.
3-Suction:
- Pull the water level in the bottle up
Creating a negative pressure
Pull the water in the tube down
Creating suction effect on the air or fluid
in the pleural cavity.
4- The Tubes :
Fixed to the thoracic wall by a
stitch and should not detached from
the patient or from the bottle.
5-Clamps:
Used when the bottle is to be
changed or removed.
*When remove the drain
When the drained fluid is
completely clear and its amount is
less than 300 cc per day.